Measuring the reliability of proxy respondents in behavioural assessments: an open question.

BACKGROUND: In behavioural assessment, information can be gathered from internally referenced self-reports or from proxy informants. AIMS: This study aimed to fine-tune a brief but reliable method for evaluating the proxy accuracy in cases where responses obtained from adult and older adults' patient cannot be considered reliable. METHODS: We generated a set of items reflecting both overt and covert behaviours related to the basic instrumental activities of daily living. The psychometric properties of the content, factorial, and criterium validity of these items were then checked. The Proxy Reliability Questionnaire-ProRe was created. We tested the frequency of "I don't know" responses as a measure of proxy reliability in a sample of healthy older adults and their proxies, and in a second sample of proxy respondents who answered questions about their parents. RESULTS: As expected, response precision was lower for items characterizing covert behaviours; items about covert compared to overt behaviours generated more "I don't know" answers. Proxies provided less "I don't know" responses when evaluating the parent, they claimed they knew better. Moreover, we tried to validate our approach using response confidence. Encouragingly, these results also showed differences in the expected direction in confidence between overt and covert behaviours. CONCLUSIONS: The present study encourages clinicians/researchers to how well the proxy the patient know each other, the tendency of proxies to exhibit, for example, response bias when responding to questions about patients' covert behaviours, and more importantly, the reliability of informants in providing a clinical assessment of neurocognitive diseases associated with aging.

The impact of age and familiarity with the environment on categorical and coordinate spatial relation representations.

Retrieving spatial information is a crucial everyday ability that is affected by age-related changes. Previous research has shown that this change is mediated by familiarity with an environment. The present research uses a series of landmark location tasks to extend and deepen our understanding of the role of aging in spatial mental representations of more or less familiar environments, also disentangling the contribution of coordinate and categorical spatial relations. The study tested the following hypotheses: (1) younger adults only have an advantage over the elderly in less familiar environments; (2) the advantage for categorical over coordinate spatial relations is mainly found for less familiar environments; and finally; (3) interactions between age, familiarity, and spatial relations might reveal that the effects of age and familiarity take different trajectories for coordinate and categorical spatial relations. Results confirmed that: (1) young people outperform the elderly only in less familiar environments; (2) there is a reduction in the difference between coordinate and categorical accuracy with increasing familiarity with the environment; while (3) the interaction between age and level of familiarity did not significantly differentiate coordinate from categorical spatial relations. In conclusion, the present study provides new evidence for the role of familiarity with geographical areas and its impact on the representation of categorical and coordinate relations, with practical implications for the assessment of topographical disorientation in aging.

The differential effect of normal and pathological aging on egocentric and allocentric spatial memory in navigational and reaching space.

BACKGROUND: Topographical disorientation (TD) refers to a particular condition which determines the loss of spatial orientation, both in new and familiar environments. TD and spatial memory impairments occur relatively early as effect of cognitive decline in aging, even in prodromal stages of dementia, namely mild cognitive impairment (MCI). AIMS: (a) To show that components linked to the recall of familiar spatial knowledge are relatively spared with respect to the learning of unfamiliar ones in normal aging, while they are not in MCI, and (b) to investigate gender differences for their impact on egocentric and allocentric frames of reference. METHOD: Forty young participants (YC), 40 healthy elderly participants (HE), 40 elderly participants with subjective memory complaints (SMC), and 40 elderly with probable MCI were administered with egocentric and allocentric familiar tasks, based on the map of their hometown, and with egocentric and allocentric unfamiliar tasks, based on new material to be learned. A series of general linear models were used to analyze data. RESULTS: No group differences were found on egocentric task based on familiar information. MCI performed worse than the other groups on allocentric tasks based on familiar information (YC = HE = SMC > MCI). Significant differences emerged between groups on egocentric and allocentric tasks based on unfamiliar spatial information (YC > HE = SMC > MCI). A gender difference was found, favoring men on allocentric unfamiliar task. CONCLUSION: Familiarity of spatial memory traces can represent a protective factor for retrospective components of TD in normal aging. Conversely, using newly learned information for assessment may lead to overestimating TD severity.

How to separate coordinate and categorical spatial relation components in integrated spatial representations: A new methodology for analysing sketch maps.

Spatial relations between landmarks can be represented by means of categories and coordinates. In the present research, this paradigm was applied to sketch maps based on information acquired in goal-directed behaviour of exploration of a university campus area. The first aim was to investigate whether categorical and coordinate information can be considered conceptually independent in sketch maps. The second aim was to assess which kind of distance measure served better to represent coordinate information in the present case study, and finally to assess the factorial structure of coordinate and categorical data. Analytic methodology as well as statistical analysis were found to confirm that separating coordinate and categorical components was formally as well as empirically appropriate. A series of confirmatory factor analyses showed the best fit for the model with two correlated components, as well as an acceptable reliability of measures emerged. The two components were moderately correlated. Moreover, the adoption of Manhattan distance seemed to be the most effective method to represent coordinate spatial relations in spatial sketch maps of areas acquired through navigation.

The Effect of Aging on Memory for Recent and Remote Egocentric and Allocentric Information.

BACKGROUND: The present study explores recent and well-consolidated spatial memory within the egocentric and allocentric frames of reference in young and elderly people. METHODS: The research included young and old participants, within the range of normality. All the participants were tested on four spatial tasks requiring allocentric and egocentric judgments, based on recent as well as remote spatial information, using a Multivariate Regression Analysis. RESULTS: An age effect on both egocentric and allocentric tasks was present in recently learned spatial information. The age effect was not present in tasks regarding well-consolidated spatial information. Finally, sex influenced the performance in allocentric tasks regarding both recent and well-consolidated memory. CONCLUSION: These data were discussed according to the Multiple Trace Theory, supporting the idea that the magnitude of difference between egocentric and allocentric judgments in aging is somewhat attributable to the characteristic of spatial tasks. In general, a lower difference between the performance of young and elderly participants is shown in tasks based on well-consolidated information when compared with tasks based on episodic information. Well-consolidated information seemed to be better preserved in memory and less prone to the impairment.

Topographical disorientation in aging. Familiarity with the environment does matter.

Topographical disorientation (TD) refers to navigational impairment as an effect of aging or brain damage. Decreases in navigational performance with aging are more due to deficits in the ability to mentally represent space in an object-centered (allocentric) than in a self-centered (egocentric) format. Familiarity/remoteness of spatial memory traces can represent a protective factor for TD in aging. Conversely, using newly learned information for assessment may lead to overestimating TD severity as it combines two contributing factors: heading (allocentric) disorientation and anterograde agnosia. A supplementary evaluation of TD with aging according to ecological spatial tasks is recommended. The core tasks should focus on landmark positioning, both on a blind map (allocentric) and along a route (egocentric) of the hometown so as to disentangle spatial memory for familiar/remote information from decline due to recent encoding of information.

Spatial reorientation decline in aging: the combination of geometry and landmarks.

OBJECTIVES: The study is focused on the assessment of reorientation skills in a sample of community-dwelling elderly people, manipulating landmarks and geometric (layout) information. METHOD: A neuropsychological assessment was administered to 286 elderly participants, divided into six groups (healthy controls, HC; four subgroups of participants with mild cognitive impairment, MCI; participants with probable dementia, Prob_D) and tested with the Virtual Reorientation Test (VReoT). VReoT manipulated different spatial cues: geometry and landmarks (proximal and distal). RESULT: Compared with HC, participants with MCI and Prob_D showed to be impaired in tasks involving geometry, landmarks and a combination of them. Both single and multiple domain impairment in MCI had an impact on reorientation performance. Moreover, VReoT was marginally able to discriminate between amnesic and non-amnesic MCI. The occurrence of getting lost events seemed to be associated to learning of geometric information. CONCLUSION: The associative strength between landmark and target plays an important role in affecting spatial orientation performance of cognitively impaired participants. Geometry significantly supports landmark information and becomes helpful with the increase of cognitive impairment which is linked to a decrement in landmark encoding. VReoT seems to represent a reliable evaluation supplement for spatial orientation deficits in prodromal stages of dementia.

Italians do it worse. Montreal Cognitive Assessment (MoCA) optimal cut-off scores for people with probable Alzheimer's disease and with probable cognitive impairment.

Montreal cognitive assessment (MoCA) is a test providing a brief screening for people with cognitive impairment due to aging or neurodegenerative syndromes. In Italy, as in the rest of the world, several validation studies of MoCA have been carried out. This study compared, for the first time in Italy, a sample of people with probable Alzheimer's Disease (AD) with healthy counterparts. The study also compared two community-dwelling groups of aged participants with and without probable cognitive impairment, as discriminated by two cut-off points of adjusted MMSE score. All the comparisons were carried out according to ROC statistics. Optimal cutoff for a diagnosis of probable AD was a MoCA score ≤14. Optimal cutoff for the discrimination of probable cognitive impairment was a MoCA score ≤17 (associated to MMSE cutoff of 23.8). Results confirm the substantial discrepancy in cut-off points existing between Italian and other international validation studies, showing that Italian performance on MoCA seems to be globally lower than that in other Countries. Characteristics of population might explain these results.

The role of pre-morbid intelligence and cognitive reserve in predicting cognitive efficiency in a sample of Italian elderly.

BACKGROUND: Models of cognitive reserve in aging suggest that individual's life experience (education, working activity, and leisure) can exert a neuroprotective effect against cognitive decline and may represent an important contribution to successful aging. AIM: The objective of the present study is to investigate the role of cognitive reserve, pre-morbid intelligence, age, and education level, in predicting cognitive efficiency in a sample of healthy aged individuals and with probable mild cognitive impairment. METHODS: Two hundred and eight aging participants recruited from the provincial region of Bari (Apulia, Italy) took part in the study. A battery of standardized tests was administered to them to measure cognitive reserve, pre-morbid intelligence, and cognitive efficiency. Protocols for 10 participants were excluded since they did not meet inclusion criteria, and statistical analyses were conducted on data from the remaining 198 participants. A path analysis was used to test the following model: age, education level, and intelligence directly influence cognitive reserve and cognitive efficiency; cognitive reserve mediates the influence of age, education level, and intelligence on cognitive efficiency. RESULTS: Cognitive reserve fully mediates the relationship between pre-morbid intelligence and education level and cognitive efficiency, while age maintains a direct effect on cognitive efficiency. DISCUSSION: Cognitive reserve appears to exert a protective effect regarding cognitive decline in normal and pathological populations, thus masking, at least in the early phases of neurodegeneration, the decline of memory, orientation, attention, language, and reasoning skills. CONCLUSIONS: The assessment of cognitive reserve may represent a useful evaluation supplement in neuropsychological screening protocols of cognitive decline.

Promoting Geropsychology: A Memorandum for Research, Policies, Education Programs, and Practices for Healthy Aging.

BACKGROUND: This viewpoint paper reports the state of the art at a global level on research, practice and assessment, policies, and training in the clinical psychology of aging and, more specifically, in geropsychology. The main sources of information were as follows: (1) the most recent reviews of the literature available in the scientific literature; (2) the resources on the internet referable to professional and academic associations dealing with the topic; and (3) the laws, policy initiatives, and funded programs that are aimed at the diffusion and applications of mental health in aging. METHODS: The present study aims to provide an updated and comprehensive memorandum highlighting the importance of prioritizing mental health in older adults. It seeks to promote health in general and disease prevention strategies, ensuring equitable access to mental health services integrated into primary care and designed for aging. This paper also aims to shed light on the slow development process and lack of consolidation in the adaptation of academic training at master's and doctoral levels in most developed countries, despite the long-declared importance of enhancing resources for the promotion of geropsychology. RESULTS: The results of the present study are patchy. Although the importance of enhancing resources for the promotion of geropsychology has long been declared, the development process seems very slow, and the adaptation of academic training at master's and doctoral levels in most developed countries-those that, for demographic reasons and attitudes, should be more sensitive to the issue, does not yet seem to have consolidated. CONCLUSIONS: Collaboration among diverse professionals is crucial for providing integrated and comprehensive care to older adults that addresses their physical, psychological, and social needs.

"Regulating my anxiety worsens the safety of my driving": The synergistic influence of spatial anxiety and Self-regulation on driving behavior.

Spatial Anxiety (SA) can be defined as the fear and apprehension experienced during tasks that require spatial thinking and may negatively impact the execution of daily actions. Although it has been explored in several research fields, limited research has explored the effects of SA on specific driving behaviours. In the current study, it was hypothesised that the severity of SA affects risky driving behaviours, and that this relationship is mediated by the driver's self-regulation abilities. Self-reported SA symptoms, driving self-regulation abilities, and risky driving behaviours (i.e., errors, violations, and lapses) were examined in 838 Italian drivers. Data were analysed through linear regressions and path analysis models, controlling for sociodemographic variables. The results showed the negative effects of SA on driving errors and lapses. As hypothesised, a driver's self-regulation abilities mediated the influence of SA on driving lapses, but not on errors nor violations. These findings suggest that the inclination to self-regulate the SA experienced while driving contribute to increase the occurrence of driving lapses. Showing specific pathways through which SA impacts risky driving, these results provide valuable insights for the development of 'driver-focused' road safety interventions.

The Four Factors of Mind Wandering Questionnaire: Content, Construct, and Clinical Validity.

Despite great interest in Mind Wandering, a fully validated questionnaire has been lacking. The Four Factors of Mind Wandering (4FMW) Questionnaire, presented here, meets this demand. First, 80 items were judged for content validity by two panels of experts. Those items that survived this content validity assessment were then tested using exploratory and confirmatory factor analyses on two independent samples of young adults. The 16 resulting items were shown to cluster into four factors (i.e., Failure in social interaction, Failure in interaction with objects, Unawareness, and Inattention). The 4FMW questionnaire showed good reliability, robust structure, and acceptable goodness-of-fit indices, as well as good convergent validity with another Mind Wandering questionnaire. Importantly, the 4FMW questionnaire was able to discriminate between attention-deficit/hyperactivity disorder and obsessive-compulsive disorder symptoms. The 4FMW Questionnaire is a reliable and valid instrument for assessing mind wandering in the young adult population.

Perceived Social Support Mediates the Relationship between Use of Greenspace and Geriatric Depression: A Cross-Sectional Study in a Sample of South-Italian Older Adults.

A growing body of evidence is suggestive for the beneficial role of contact with greenspace (e.g., use of greenspace, visual access to greenspace, etc.) on mental health (e.g., depression, anxiety, etc.). In addition, several studies have pointed out the benefits of social support and social interaction on psychological wellbeing. Even if evidence on the association between contact with greenspace and perceived social support were mixed, it was supposed that the use of greenspace could enhance social interactions and perceived social support, especially among older adults. The present study aims to explore the effect of use of greenspace on geriatric depression in a sample of South-Italian older adults and the mediating role of perceived social support in this association. A structural equation model was tested in a sample of 454 older adults (60-90 years old) residing in the Metropolitan Area of Bari, Apulia. The fit indices revealed the goodness of fit of the model (CFI = 0.934; TLI = 0.900; IFI = 0.911; NFI = 0.935; RMSEA = 0.074; SRMR = 0.056). Results showed that the use of greenspace was inversely associated with geriatric depression through perceived social support. These findings underlined the relevance of perceived social support on the pathway linking use of greenspace and geriatric depressive symptoms. This evidence may be useful to policymakers to plan interventions for promoting physical access to greenspace and social participation in an age-friendly city framework.

The Relationships between Compulsive Internet Use, Alexithymia, and Dissociation: Gender Differences among Italian Adolescents.

Internet Gaming Disorder, Internet Addiction, Problematic Internet Use and Compulsive Internet Use cause distress and significant impairment in important areas of a person's functioning, in particular among young people. The literature has indicated that males show higher levels of problematic internet use than females. People can use the internet to avoid or alleviate negative affects; in fact, problematic internet use is associated with alexithymia and dissociation. Few studies have focused on the different stages of adolescence, gender differences, and the relationships between the aforementioned variables. This research aims to fill this gap. Five hundred and ninety-four adolescents aged between 13 and 19 filled in the Compulsive Internet Use Scale, the Toronto Alexithymia Scale, the Adolescents Dissociative Experiences Scale, and other ad hoc measures. Surprisingly, females reported higher compulsive internet use compared with males. Moreover, they referred more difficulties/symptoms and greater levels of alexithymia than males. No differences across the stages of adolescence were found. Different strengths in the relationships between variables were found according to gender. Moderated mediation analyses indicated that dissociation is an important mediator in the relation between alexithymia and Compulsive Internet Use only among females. This study shed new light on gender differences around problematic internet use and some related risk factors, in order to identify and develop prevention and treatment programs to face this topical and relevant issue.

Distortions in Spatial Mental Representation Affect Sketch Maps in Young Adults.

Humans tend to misrepresent spatial information which leads to systematic errors due to distorted organizational processes regarding metric and positional judgments. This study is aimed at analyzing metric and positional distortions in cognitive maps by using external representations, namely sketch maps, in two experiments with young participants. In the first experiment, we use the sketching area of Northern Europe. In the second experiment, the University campus area was used. The first aim was to test the hypothesis that the presence of the sea between the triplet of landmarks generates an overestimation of the distances between them in the case of Northern Europe; and to test the hypothesis that the number of turns in a route influences the overestimation of the distance between landmarks in the case of the campus area. The second aim was to investigate alignment and rotation errors using the same maps. Concerning metric errors, the results showed the overestimation of distances with a geographical gap between the cities (the sea in the Northern European Area), and those with more turns between landmarks (the campus area). The results concerning rotations and alignments were in line with the previous research about positional errors. The present study extended findings on distortions in spatial mental representation as emerging from verbal judgments, to sketch maps: direct visuospatial external representations eluding the conversion into verbal coding of spatial information. The presence of distortions in cognitive maps could be considered the consequence of the encoding of spatial information.

What These Findings Tell Us. Reply to Kelly et al. What Do These Findings Tell Us? Comment on "Tinella et al. Cognitive Efficiency and Fitness-to-Drive along the Lifespan: The Mediation Effect of Visuospatial Transformations. Brain Sci. 2021, 11, 1028".

The study of the contribution of spatial transformation skills to driving behavior is a research topic substantiated by scarce evidence. In previous studies, we found that mental rotation and perspective-taking skills have an influence on performance in driving tasks by conveying the distal effects of the general cognitive efficiency on the execution of driving maneuvers. Studies have provided evidence on the relevance of the cognitive processes of encoding, imagined rotation, and spatial orientation in the accuracy of both the vehicle management during stressful driving situations and the acquisition of visual information on the traffic scenario. Results can find applications in both the training and the assessment of fitness to drive, as well as in the study of interaction between the drivers and in-vehicle devices. The lack of cross-validations in path analysis models cannot be assumed, a priori, to be capitalizing on chance and as an example of bad science. The non-replicability of a study should be demonstrated before it is proclaimed. The purpose of this reply was to address the questions raised by Kelly et al. (2022)-that is, "Do these results seem replicable?" and "How do these results advance our understanding of brain function and/or human behavior?"-by providing additional information on the study in question.

The Prevalence of Amnestic and Non-Amnestic Mild Cognitive Impairment and Its Association with Different Lifestyle Factors in a South Italian Elderly Population.

Mild Cognitive Impairment (MCI) is a transition stage between normal aging and dementia and can be useful to monitor the cognitive status of people at risk of dementias. Our aims were to investigate the prevalence of amnestic and non-amnestic MCI in a South Italian elderly population, and to identify socio-demographic, clinical and lifestyle factors associated with MCI. A cross-sectional retrospective population study on 839 community-dwelling participants over 60 years of age was carried out. Elderly people were administered a brief neuropsychological screening to identify their cognitive and functional status, and a questionnaire to investigate several socio-demographic, clinical, and lifestyle factors. Prevalence estimate for MCI was 12.0% (95% CI: 10.0-14.5%), for amnestic MCI was 7.4% (95% CI: 5.8-9.4%), and for non-amnestic MCI was 4.6% (95% CI: 3.4-6.4%), for people older than 60 years of age. Logistic regression models, corrected for age, sex, and education, revealed a significant association of MCI with the following factors: age, education, intellectual activities, and topographical disorientation. On the other hand, education, clinical factors (e.g., depression level and perceived physical pain), lifestyle factors (e.g., smoking, alcohol, and leisure/productive activities), dietary habits, quality of life, and self-reported topographical disorientation were non-significantly associated with MCI. Prevalence estimates and the association of MCI and its subtypes with risk and protective factors were discussed in comparison with the most recent systematic reviews and meta-analyses.

Long-Term Exposure to Greenspace and Cognitive Function during the Lifespan: A Systematic Review.

Recent advances in environmental psychology highlighted the beneficial role of greenspace exposure on cognition. We conducted a systematic review of the available studies on the association of long-term exposure to greenspace and cognitive functions across the lifespan. PRISMA guidelines and the PECOs method were applied to screen for eligible studies. Twenty-five studies from Scopus, PubMed, and PsycINFO met the inclusion criteria. Six studies were longitudinal and nineteen cross-sectional. Fifteen studies focused on schoolchildren, six studies on adults, and four on the elderly. Twenty studies used the NDVI to assess greenspace exposure and the remaining used other indexes. Eight studies employed academic achievement as the outcome, eight studies global cognition, six studies attention/executive functions, and three studies memory. The evidence was inconsistent but suggestive for a beneficial role of greenspace exposure on cognitive functions. Further studies are required, especially among adults and older people, by adopting longitudinal designs.

Space at home and psychological distress during the Covid-19 lockdown in Italy.

Prolonged periods of restrictions on people's freedom of movement during the first massive wave of the COVID-19 pandemic meant that most people engaged in all their daily activities at home. This suggested the need for the spatial features of the home and its occupants' perception of them to be investigated in terms of people's wellbeing. The present study was conducted on a large sample (N = 1354) drawn from different Italian regions. It examined the relationship between the "objective" and "subjective" dimensions of the home, measured in terms of objective home crowding and satisfaction with the space at home, in relation to perceived stress and the perceived risk of COVID-19 infection during the lockdown. The results showed that perceived stress is influenced by objective home crowding through the mediation of satisfaction with the space at home. These associations were more pronounced in younger generations. The negative association between satisfaction with the space at home and perceived stress was higher, the lower the perceived COVID-19 risk.

The Impact of Two MMPI-2-Based Models of Personality in Predicting Driving Behavior. Can Demographic Variables Be Disregarded?

The driver's personality is a key human factor for the assessment of the fitness to drive (FTD), affecting driving decisions and behavior, with consequences on driving safety. No previous study has investigated the effectiveness of Minnesota Multiphasic Personality Inventory (MMPI)-2 scales for predicting the FTD. The present study aimed to compare two MMPI-2-based models of normal and pathological personality traits (i.e., Inventory of Driving-related Personality Traits (IVPE)-MMPI vs. Personality Psychopathology Five (PSY-5) scale) in predicting the cognitive FTD. One hundred young and eighty-seven adult active drivers completed the MMPI-2 questionnaire as a measure of personality and a computerized driving task measuring for resilience of attention (Determination Test (DT)), reaction speed (Reaction Test (RS)), motor speed (MS), and perceptual speed (Adaptive Tachistoscopic Traffic Perception Test (ATAVT)). The effects of age, gender, and education were also controlled. Results showed that the models controlled for demographics overperformed those neglecting them for each driving outcome. A negative effect of age was found on each driving task; the effect of gender, favoring males, was found in both the RS and the MS, and the effect of education was found on the DT and the ATAVT. Concerning personality traits, significant effects were found of sensation seeking (IVPE-MMPI) on each outcome; of anxiety (as a measure of emotional instability; IVPE-MMPI) and introversion (PSY-5) on the measures of MS; and of psychopathic deviation (as a measure of self-control; IVPEMMPI) on the DT. The study confirmed the key role of demographic factors in influencing the FTD, further suggesting the usefulness of some MMPI2-based personality scales in the assessment of driving-related personality determinants.